In Aug 1998, a 150-bed naval hospital in eastern North
Carolina identified an outbreak in the newborn nursery. Cases
were newborn males who had undergone a
circumcision procedure and post-discharge required
antimicrobial treatment for severe pustulous diaper rash. A
total of 36 cases were identified from Aug to Jan 1999. All
17 cases that were cultured grew methicillin-sensitive,
erythromycin-resistant Staphylococcus aureus.
Extensive environmental culturing of the nursery unit and
circumcision procedure equipment did not reveal an inanimate
reservoir for the S. aureus. Initial infection control
measures (Aug) to review aseptic technique and instrument
sterilization procedures were ineffective. In Jan additional
control measures included enforcement of glove wearing for
all diaper changes and limited post-circumcision care to one
healthcare worker (HCW) per newborn. In Feb all HCWs (MDs,
RNs, LPN and corpmen) were cultured by anterior nasal swabs
and hand swab cultures. Fourteen (14) HCWs had positive
cultures identified with S. aureus. Pulse field gel
electrophoresis (PFGE) were performed on 13 of the 17 case
isolates. All 13 case isolates were identical. All 14 HCWs
identified with S. aureus were compared to the >13
cases by PFGE, and 3 HCWs (2 RN, 1 LPN) matched identically.
One of these HCWs had a chronic cough, and a second had
concealed dermatititis. This suggests that these DCWs were
disseminators in light of the prolonged nature of the
outbreak. Antimicrobial decolonization was instituted for the
HCWs and there was one additional case in Mar. In conclusion,
HCWs identified by DNA testing may have represented the
reservoir of infection in this outbreak.

[CIRP Note: This paper represented by this
abstract was presented at the 4th Decennial International
Conference on Nosocomial and Healthcare-Associated
Infections, Atlanta, March 5-9, 2000.]